Ronnie Musgrove: Delaying Medicaid expansion is costing Mississippi


Ronnie Musgrove



Recently, an article appeared in the Mississippi Business Journal recommending the State of Mississippi not adopt Medicaid expansion. The argument made was now is not the time to expand Medicaid, because "right now the real challenge is prioritizing very limited healthcare resources." Further, "we need to be spending health care dollars on people who are sick, dying or have a crippling disease." What?


According to Fox Business, Mississippi has remained the unhealthiest state for most of the past 20 years.


To say the article missed the mark is an understatement. With Medicaid expansion, Mississippi would receive $11 billion to help with "limited healthcare resources." This is no longer a partisan issue. Thirty-nine states in the country have adopted a version of health care expansion. In all instances, states that have implemented expansions received much-needed healthcare dollars.



Many states have Republican governors and are controlled by Republican legislators, so this is not a decision based on "liberal" views but on recognition that affordable health care is in the states' long-term best interest. For Mississippi, it would have been $11 billion if we had passed a program when it was enacted (2012). It would have created over 9,500 new jobs. The first three years would have been covered 100 percent by the federal government. For each year we haven't adopted a program of healthcare expansion via Medicaid, it has cost us $1 billion. So, we have lost $8 billion that will never come again.


Mississippi has a history of coming around and doing what is in the best interest of the state and her citizens, after everyone in the country has done it before us and gained the benefits from adoption of the programs. The nagging question which lingers is "how much did it cost us in the interim when we did not adopt the program?" Several examples are apparent. The adoption of a new flag; we were the last state in the nation to provide state-funded kindergarten; we were the last state to end prohibition.


Pre-kindergarten is the last example I will use. We are one of the few states not offering pre-k to all children. The data are irrefutable. Dr. James Heckman (University of Chicago Nobel Prize recipient in Economics) lays out the economic advantages to high quality early childhood programs, and his research shows a 13 percent annualized return on investment realized in improved school achievement, reduced need for special education, higher earnings and reduced reliance on government benefits as adults, among other economic benefits.


There are other examples when Mississippi has delayed action to our own detriment, but you get the point.


When Hurricane Katrina hit the Mississippi Gulf Coast, what did the federal relief package contain? Money. We spent every penny. When the Great Recession of 2008 happened, what did the federal relief package contain? Money. We spent every penny. When Covid-19 hit the country, but specifically Mississippi, what did the federal government do? Send money, and lots of it. The governor and legislature will spend every penny of the $1.25 billion aid package.


Money was necessary in each situation to stabilize the crises and allow the state and the economy to recover. In each one of these instances, money was provided as a remedy. Time was of the essence. No one raised the issue then that we may have to pay the money back, that we wouldn't get it the next year, or that because we may have used some to prop up some ongoing state expenditures we couldn't take the money because it would force us to alter future programs since the "tap" may be turned off.


Why are state leaders taking a completely different approach when it comes to $11 billion for health care? The money is for preventive care to reduce the likelihood (and expense) of life-threatening conditions in the future, and for treatment of heart disease, diabetes, cancer, heart attacks, accidents, and other life-threatening illnesses.


Those who work at the auto parts store, the grocery store, convenience stores, pulp wood haulers, plumbers, electricians, and so many others who make too much to qualify for federally-funded insurance exchange coverage but not enough to pay for health insurance are on their own. The best rates available for health insurance for an average family of 2-4 people ranges from $1,000-$1,500 per month. How many of our neighbors without health care can afford that much per month? Without some financial help, all of these Mississippians are going without health insurance and are not going to see a doctor or hospital. If they do, they are going to the emergency rooms and, in that case, no payments are being made to the hospital.


According to the Mississippi Hospital Association, the high number of uninsured people in Mississippi results in over $600 million each year in uncompensated care costs for our hospitals. Hence the problem of financial distress for Mississippi hospitals.


The most recent and comprehensive study conducted by researchers at Vanderbilt University School of Medicine in collaboration with Harvard Medical School found better health outcomes in states that expanded Medicaid. John Graves, author of the study, stated "we now have the actual evidence showing that non-expanding Southern states could materially improve population health if they accept expansion funds."


As more data become available, there is more evidence that expansion of the Affordable Care Act has a positive effect on the health of citizens and on state economies. Another study also found expansion of Medicaid would save as many lives as seatbelts.


We see what happens when we "save the debate for a later day". It has been the story of Mississippi for decades. Let's put off till tomorrow what will help us today.


A shame.



Ronnie Musgrove is former Governor of the State of Mississippi.


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